Mind the gap: A qualitative assessment of limitations in school-age immunisation programme delivery for Orthodox Jewish children in northeast London

INTRODUCTION: School-based vaccine programme delivery offers convenience to parents, and reduces the burden on primary care capacity. Vaccine coverage among school-age children is lower in Hackney (northeast London), and post-pandemic coverage recovery has been limited in Hackney compared to London and England. Hackney is home to the largest Orthodox Jewish (OJ) population in Europe where most children attend independent faith schools. This study aimed to assess (i): vaccine programme delivery gaps via independent OJ schools in Hackney; and (ii) the primary care catch-up and commissioning strategies undertaken to help close gaps. METHODS: Qualitative evaluations of national incident responses for poliovirus and measles tailored to underserved communities in northeast London (2022-24). Data consisted of in-depth semi-structured interviews (n = 53) with public health professionals, healthcare practitioners, community partners, and OJ parents. Vaccine clinic visits (n = 11) were conducted in northeast London, affording additional (n = 43) focused and opportunistic interviews with OJ parents attending for catch-up. RESULTS: Evaluating the delivery of routine and outbreak vaccination campaigns to school-age children demonstrates that independent OJ schools in Hackney are a key programme delivery gap, directly impacting access to catch-up and routine adolescent programmes. OJ parents reported that they did not receive relevant vaccine programme information and invitations for school-age children via independent faith schools. Primary care-led outreach clinics were hosted to offer school-age immunisations to OJ adolescents, but did not offer HPV vaccines. Sub-commissioning community organisations to liaise with independent schools may be a strategy to help resolve this delivery gap, but would require responsibilities within school-age immunisation partnerships to be clearly assigned. CONCLUSION: Limitations in vaccine programme delivery via independent faith schools in northeast London may play a role in suboptimal vaccination coverage. Programme gaps must be addressed to help ensure that every eligible child is invited for, and can access, routine vaccination via accessible pathways.